Healthcare Provider Details

I. General information

NPI: 1750204640
Provider Name (Legal Business Name): BRIANNE RODRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E 2ND ST STE 101
CASPER WY
82601-2578
US

IV. Provider business mailing address

232 E 2ND ST STE 101
CASPER WY
82601-2578
US

V. Phone/Fax

Practice location:
  • Phone: 307-258-8380
  • Fax:
Mailing address:
  • Phone: 307-258-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number33230
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: